18F-FDG PET显像诊断恶性肿瘤初步应用

目的　探讨注射１８ＦＦＤＧ行正电子发射计算机断层（ＰＥＴ）,诊断恶性肿瘤的影像特征和应用价值。方法　应用１８ＦＦＤＧＰＥＴ胸腹部断层显像和标准化摄取值（ＳＵＶ） 评价１０ 例正常人和１８ 例经病理和临床证实的恶性肿瘤病人。结果　所有恶性肿瘤灶均呈较正常组织明显增高的放射性摄取,其中原发灶１８ 个,平均ＳＵＶ 值４－４２±１－２９;转移灶１９ 个,平均ＳＵＶ值２－０６±０－５６。结论　１８ＦＦＤＧＰＥＴ显像对于探测恶性肿瘤原发灶和转移灶具有很高价值。     

18F-FDG PET/CT半定量分析诊断颈部淋巴结转移癌的价值

目的 探讨18 F-FDG PET/CT诊断颈部淋巴结转移癌的价值.方法 回顾性分析48例颈部淋巴结肿大患者的CT、PET及PET/CT图像,在CT图像上分别以淋巴结最短径＞0.5 cm(A标准)、最短径＞1.0 cm(B标准)及最长径＞1.0 cm(C标准)为判定淋巴结转移的诊断标准;在PET图像上,以淋巴结出现异常18F-FDG摄取浓聚灶最大标准化摄取值(SUVmax)＞2.5(D标准),SUVmax＞1.93(E标准)、TSUVmax/NSUVmax＞3.11(F标准)为判定淋巴结转移的诊断标准;在PET/CT图像上,将结合CT图像A标准及PET图像E标准确定的G标准为判定以淋巴结转移的诊断标准.以病理诊断为标准,比较不同影像标准在颈部淋巴结转移中的诊断价值.结果 颈部阳性淋巴结与阴性淋巴结在最长径、最短径、SUVmax值之间的差异均有统计学意义.7种标准中,PET(E标准)及PET/CT(G标准)具有较高的诊断准确率与病理吻合度,与单纯CT比较具有较高诊断价值.不同PET及PET/CT诊断标准差异无统计学意义.结论 18F-FDG PET/CT对颈部淋巴结转移的诊断具有较高的临床价值.     

18F-FDG PET/CT诊断非小细胞肺癌纵隔淋巴结转移

目的 探讨¹⁸F-FDG PET/CT诊断非小细胞肺癌（NSCLC）纵隔淋巴结转移的价值。方法 回顾性分析130例初诊NSCLC患者（337个纵隔淋巴结）术前PET/CT资料,与术后病理结果相对照,评价PET/CT诊断NSCLC纵隔淋巴结转移的灵敏度、特异度及准确率。结果 以患者为观察单位,PET/CT发现纵隔淋巴结转移66例,无纵隔淋巴结转移64例,灵敏度79.41%（54/68）,特异度80.65%（50/62）,准确率80.00%（104/130）,阳性预测值81.82%（54/66）,阴性预测值78.13%（50/64）;以淋巴结数为单位,PET/CT诊断纵隔淋巴结转移125个,非纵隔淋巴结212个,PET/CT诊断纵隔淋巴结转移的灵敏度74.42%（96/129）,特异度86.06%（179/208）,准确率81.60%（275/337）,阳性预测值76.80%（96/125）,阴性预测值84.43%（179/212）。PET/CT结果与病理结果比较差异无统计学意义。结论 ¹⁸F-FDG PET/CT诊断NSCLC纵隔淋巴结转移具有较高价值。     

18F-脱氧葡萄糖PET/CT对宫颈癌分期及预后的临床价值

近年来随着影像技术不断进步,成像形式从反映病变解剖结构发展到反映病变代谢及功能特征。18F-脱氧葡萄糖(18F-FDG)PET/CT显像作为分子成像的重要组成,已在临床逐步应用,尤其广泛应用于妇科常见肿瘤宫颈癌中。大量临床应用表明,PET/CT具有更准确的临床分期能力,能更早地判断治疗疗效响应、监测复发和残留肿瘤,以更好地判断预后,较CT和MRI展示出巨大优势和前景。     

18F-FDG PET/CT检测淋巴结转移癌原发灶

目的 观察¹⁸F-FDG PET/CT检测淋巴结转移癌原发灶的价值。方法 回顾性分析133例接受¹⁸F-FDG PET/CT检查的淋巴结转移癌患者,以临床综合诊断结果为标准,与淋巴结免疫组织化学结果对比,评估PET/CT检出淋巴结转移癌原发灶的效能。结果 ¹⁸F-FDG PET/CT检出淋巴结转移癌原发灶的敏感度、特异度、假阳性率、假阴性率、阳性预测值及阴性预测值分别为84.09%(37/44)、82.02%(73/89)、17.98%(16/89)、15.91%(7/44)、69.81%(37/53)及91.25%(73/80),淋巴结免疫组织化学分别为41.03%(16/39)、69.15%(65/94)、30.85%(29/94)、58.97%(23/39)、35.56%(16/45)及73.86%(65/88),前者的敏感度高于后者(P＜0.001);¹⁸F-FDG PET/CT及淋巴结免疫组织化学检出淋巴转移癌原发灶的曲线下面积分别为0.83和0.62。结论 ¹⁸F-FDG PET/CT用于检测淋巴结转移癌原发灶具有一定临床应用价值。     

18F-FDG PET/CT代谢参数预测早期宫颈癌盆腔淋巴结转移

目的 探讨¹⁸F-FDG PET/CT显像代谢参数预测早期宫颈癌盆腔淋巴结转移的价值。方法 回顾性分析接受盆腔淋巴结清扫术的国际妇产科联盟（FIGO）分期为Ⅰa~Ⅱa期的286例宫颈癌患者的PET/CT资料,计算PET/CT诊断淋巴结转移的准确率、灵敏度及特异度,测量原发肿瘤病灶的PET/CT代谢参数：最大标准摄取值（SUV_max）、平均标准摄取值（SUV_mean）、糖酵解总量（TLG）及肿瘤代谢体积（MTV）。比较淋巴结转移与无淋巴结转移患者间代谢参数的差异,并对有统计学意义的参数联合PET/CT诊断结果进行多因素分析,获得联合预测模型,绘制联合预测模型诊断淋巴结转移的ROC曲线,计算曲线下面积（AUC）,并与PET/CT诊断结果进行比较。结果 286例中,病理证实淋巴结转移63例（淋巴结转移组）,无转移223例（无淋巴结转移组）,2组间原发灶TLG、MTV差异有统计学意义（P均<0.05）,SUV_max、SUV_mean差异无统计学意义（P均>0.05）。多因素分析显示,原发灶TLG、MTV及PET/CT诊断结果均是早期宫颈癌盆腔淋巴结转移的独立危险因素,联合预测模型诊断淋巴结转移的ROC曲线的AUC为0.805（P<0.05）,优于PET/CT定性诊断（Z=3.044,P=0.002）,后者的AUC为0.717。结论 ¹⁸F-FDG PET/CT早期宫颈癌代谢参数TLG、MTV联合PET/CT定性诊断结果预测盆腔淋巴结转移具有一定价值,高于传统PET/CT定性诊断。     

18F-FDG PET显像在诊断消化道良恶性肿瘤和术后随访中的应用价值

目的通过18F-FDG PET显像在消化道良恶性肿瘤鉴别诊断和随访结果,与CT/MR和手术病理结果的对比研究,以评价PET在消化道肿瘤中的临床应用价值.方法消化道恶性肿块13例(胰腺癌10例,直肠癌2例和肝癌1例)、良性肿块5例和恶性肿瘤(胃癌5例,直肠癌4例和肝癌1例)手术治疗后10例共28例患者进行18F-FDG PET全身显像,采用双盲法将PET诊断结果与同期的CT/MR影像结果进行比较.结果 13例消化道恶性肿块PET和CT/MR均见原发灶病变,10例PET显像结果与CT/MR相同,另外3例胰腺癌患者PET显像见腹腔淋巴结和脊柱转移.5例良性消化道占位性病变PET全身显像均阴性,其中1例病例病理诊断为直肠腺瘤.10例消化恶性肿瘤术后随访中有3例PET阳性结果与CT/MR相同,4例PET全身显像阴性,另外3例PET显像见其他部位病灶.结论18F-FDG PET显像对原发性恶性肿瘤的诊断、良恶性肿块的鉴别诊断具较高的准确性和特异性,对恶性肿瘤治疗后随访确认或排除肿瘤残留和复发以及发现全身部位的转移等具有良好的临床应用价值,其对全身转移病灶的定性和定位诊断优于CT/MR.     

18F-FDG PET 显像寻找转移瘤原发灶初步应用

目的利用PET寻找转移瘤原发灶,探讨其影像特征和应用价值.方法应用18F-FDGPET于15例病人,10例经活检或手术发现肿瘤转移灶,3例胸腔穿刺发现肿瘤细胞,2例头颅MRI提示颅内转移瘤.采用PET胸腹部显像和标准化摄取值(SUV)进行评价.结果12例病人于临床发现的肿瘤转移灶部位可见明显或中度示踪浓聚,SUV2.93±0.33;3例胸腔积液病人呈片状示踪分布.14例病人经PET显像发现肿瘤原发灶,3例位于肝脏、2例位于乳腺、9例位于肺脏.转移灶与原发灶的显影类型分为三种9例转移灶明显显影,原发灶也明显显影;2例转移灶中度显影,原发灶轻度显影;3例胸腔积液处片状示踪分布,原发灶明显显影.但有1例MRI诊断颅内转移瘤的病人,PET显像未能找到原发灶,经半年随访观察尚未发现其它肿瘤灶.结论应用18F-FDGPET显像寻找转移瘤原发灶是一种简便、快速、无创、灵敏的方法,其准确度达90%以上,可作为解决此类问题的首选方法.     

18F-FDG PET/CT在原发灶不明的淋巴结转移癌中的应用价值

目的 探讨¹⁸F-FDG PET/CT全身显像对诊断原发灶不明的淋巴结转移癌(LCUP)的临床价值。方法 回顾性分析以活检证实淋巴结转移为首发症状的34例LCUP患者资料,常规检查均未找到原发灶。对全部患者行¹⁸F-FDG PET/CT全身显像,与临床随访及组织病理学结果进行比较。结果 3例淋巴瘤患者被排除,¹⁸F-FDG PET/CT检出可疑原发灶25例,正确检测出原发灶13例,检出率为41.94%(13/31);其中8例经病理证实,5例为临床诊断,阳性预测值为52.00%(13/25)。未找到原发灶的6例患者中,3例经随访尚未明确诊断。结论 ¹⁸F-FDG PET/CT全身显像在寻找LCUP的原发灶中具有重要临床价值。     

18F-DCFPyL PET/CT术前诊断前列腺癌区域转移淋巴结

目的 观察¹⁸F-DCFPyL PET/CT显像术前诊断前列腺癌区域淋巴结转移的价值。方法 回顾性分析49例同时接受前列腺根治性切除术及盆腔淋巴结清扫术的前列腺癌患者的术前¹⁸F-DCFPyL PET/CT图像及其临床资料，统计术中清扫淋巴结总数及转移淋巴结情况，计算¹⁸F-DCFPyL PET/CT对区域转移淋巴结的诊断效能，比较切除后转移淋巴结与非转移淋巴结的长径、中径及短径。结果 49例共清扫511枚淋巴结，其中10例共14枚淋巴结转移，¹⁸F-DCFPyL PET/CT正确诊断出其中9例共12枚转移淋巴结。¹⁸F-DCFPyL PET/CT术前诊断前列腺癌区域淋巴结转移的灵敏度为90.00%，特异度为100%，准确率为97.96%，阳性预测值为100%，阴性预测值为97.50%。切除后转移淋巴结与非转移淋巴结的长径均值为（1.64±0.33）cm和（1.12±0.79）cm，中径（1.05±0.23 cm）和（0.59±0.51）cm，短径（0.61±0.14）cm和（0.36±0.24）cm，差异均无统计学意义（P均>0.05）。结论 ¹⁸F-DCFPyL PET/CT对前列腺癌区域淋巴结转移具有较高诊断价值。     

口腔鳞状细胞癌颈淋巴结转移术前评价

目的 :准确评价口腔鳞状细胞癌 (oralsquamouscellcarcinomaOSCC)颈淋巴结转移。方法 :采用临床TNM分类、组织病理分级、肿瘤生长类型、淋巴细胞浸润、肿瘤浸润厚度等对 6 4例OSCC进行观察多因素分析。结果 :TNM分类、组织病理分级、肿瘤生长类型、淋巴细胞浸润程度不能准确反     

Detecting Metastasis of Lymph Nodes and Predicting Aggressiveness in Patients With Breast Carcinomas

Objective. The purpose of this study was to evaluate the contrast‐enhanced ultrasonographic (CEUS) characteristics of metastatic lymph nodes (LNs) and to determine the correlation of CEUS parameters with the tumor aggressiveness in patients with breast cancer. Methods. Real‐time gray scale CEUS of axillary LNs was preoperatively performed in 51 consecutive patients with breast carcinoma who were scheduled for axillary lymph node dissection. The CEUS characteristics assessed by a direct visualization method and quantification software were compared with pathologic findings. Expression of human epidermal growth factor receptor 2 (HER‐2/neu) in the primary tumor was detected by immunohistochemical analysis. Correlation analysis of CEUS parameters with HER‐2/neu expression and the LN stage was performed. Results. Of the LNs examined, 27 were metastatic, and 25 were diagnosed as reactive hyperplasia. Lymph nodes with metastasis were characterized by centripetal progress (66.7%) and a heterogeneous pattern (55.6%) or no or scarce perfusion (25.9%). However, LNs with nonmetastases were characterized by with centrifugal enhancement (56.0%) and a homogeneous pattern (80.0%). The difference between the hyperintense and hypointense regions was higher in metastatic LNs than nonmetastatic ones (P < .001). No significant differences were found in the arrival time, time to peak intensity, and peak intensity between the two groups. A histopathologic diagnosis could be predicted with sensitivity, specificity, and accuracy of 92.6%, 76.0%, and 84.6% respectively, by a standardized difference between maximum and minimum signal intensity (SI_max–SI_min) value of 28. Human epidermal growth factor receptor 2 expression and the LN histopathologic stage were significantly associated with the SI_max–SI_min. In metastatic LNs, the relationship between the diagnostic sensitivity of CEUS and the transverse diameter of LNs remained statistically significant (P < .05). Conclusions. Noninvasive CEUS can play a role in discriminating metastatic from nonmetastatic LNs and predicting the aggressiveness in patients with breast cancer.     

Prospective Comparison of FDG and FET PET/CT in Patients with Head and Neck Squamous Cell Carcinoma

Aim  The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. Materials and Methods  Twenty-seven patients (20 men and seven women, aged 48–76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. Results  Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p < 0.02) and specificity with FET (p < 0.01). The statistical level of significance was not reached at patient level. Conclusion  Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET− focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.     

Cytokeratin表达在舌鳞癌淋巴结微转移诊断中的应用

目的:研究一种检测舌鳞癌淋巴结微灶转移的方法.方法:对40例舌鳞癌患者及清扫淋巴结163个(常规临床检查颈部淋巴结阴性pN0)进行常规病理检查(HE染色)和细胞角蛋白(Cytokeratin,CK)抗体的免疫组化检测.结果:40例舌鳞癌组织中CK均表达阳性,40例颈淋巴结常规病理检查(HE染色)发现5例有转移者(共23枚淋巴结),CK检测也为阳性.19个淋巴结常规病理检查未发现转移者,CK也表达阳性.随着肿瘤T分期的增加,淋巴结CK表达阳性率亦增加.CK表达阳性者预后较阴性者差.结论:CK免疫组化法是检测舌鳞癌淋巴结微转移的敏感而便捷的方法,而检测舌鳞癌微转移有助于判断肿瘤进展程度与预后,特别对筛选组织学检查淋巴结阴性但存在微转移的患者有实用价值.     

PET-CT对肿瘤淋巴结转移的诊断作用评价

目的：探讨PET-CT融合显像对肿瘤淋巴结转移的诊断价值。方法：回顾对比研究23例恶性肿瘤伴淋巴结肿大患者的PET-CT、CT/MRI及病理资料。结果：PET-CT对肿瘤淋巴结诊断敏感性和准确度分别为93.7%和86.9%,CT诊断的敏感性和准确度分别为62.5%和69.6%。结论：PET-CT融合显像对肿瘤伴淋巴结肿大是否为癌转移有诊断价值,明显优于CT/MRI,可作为手术或放疗的重要依据,也是肿瘤临床分期的重要依据。     

Small Atypical Cervical Nodes Detected on Sonography in Patients With Squamous Cell Carcinoma of the Head and Neck

Objective. The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck. Methods. .We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and 30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4‐point scale: 1, definitely benign; 2, indeterminate (small [short‐axis diameter <10 mm for levels I and II and <7 mm for levels III–VI] atypical node); 3, definitely metastatic; and 4, large (>3‐cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long‐ to short‐axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level‐by‐level basis, with histopathologic findings. Results. Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. The probability of metastasis was significantly higher with than without a large (>3‐cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904). Conclusions. Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck.     

喉鳞状细胞癌全喉切除术后复发和颈部转移

目的：探讨喉鳞状细胞癌全喉切除术后的复发和颈淋巴结转移特点。方法：回顾分析108例因喉鳞状细胞癌行全喉切除手术的病例资料。结果；108例喉鳞状细胞癌患者有48例出现颈淋巴结转移，有8例局部复发，局部复发者预后差。48例出现颈淋巴结转移者中，有18例颈淋巴结转移发生于全喉切除手术之前，30例颈淋巴结转移发生于全喉切除手术之后。声门上型喉鳞状细胞癌比声门型容易发生颈淋巴结转移（P〈0.01），T3和T4期患者比T2期患者容易发生颈淋巴结转移（P〈0．01）。结论：颈淋巴结转移是喉鳞状细胞癌患者的常见现象，外科医师应警惕喉鳞状细胞癌颈淋巴结的高转移特性，并制定合适的治疗方案。对晚期和声门上型喉鳞状细胞癌应进行密切的术后随访。     

超声评估乳癌患者腋下淋巴结转移的临床价值

目的:通过对乳癌原发灶的灰阶超声,彩色多普勒(Color Doppler Flow Imaging,CDFI),频谱多普勒检查,评估腋下淋巴结有无转移。方法:术前运用超声检测122例乳癌患者原发灶的声学特性,术后根据腋下淋巴结有无转移分为两组,比较两组间年龄,原发灶的部位(象限分布),大小,内部回声,有无卫星灶,CDFI,频谱多普勒有无显著差异。结果:患者的年龄,内部回声,有无卫星灶,两组间无显著性差异;原发灶的大小,部位两组间有显著差异;CDFI显示:腋下淋巴结阳性组原发灶内血流比阴性组丰富(P<0.05);频谱多普勒显示:阳性组峰值流速(Vmax)高于阴性组(P<0.01),其中Vmax>33cm/s的14例患者腋下淋巴结均呈阳性。阻力指数(RI):两组间无显著差异,但如把RI=1的8位患者单独列组,两组间有显著差异(P<0.01)。结论:运用灰阶超声、多谱勒超声评价癌肿的声学特性,对判断腋下淋巴结状态,指导临床治疗,有一定帮助。     

18F-FET PET/CT in Advanced Head and Neck Squamous Cell Carcinoma: an Intra-individual Comparison with 18F-FDG PET/CT

Molecular Imaging and Biology - To assess the diagnostic value of O-2-fluoro-18(F)-ethyl-l-tyrosine (18F-FET) positron emission tomography/computed tomography (PET/CT) for patients with advanced...